Approach to prophylactic measures for central venous catheter-related infections in hemodialysis: A critical review

Vascular access is the major risk factor for bacteremia, hospitalization, and mortality among hemodialysis (HD) patients. The type of vascular access most associated with bloodstream infection is central venous catheter (CVC). The incidence of catheter-related bacteremia ranges between 0.6 and 6.5 episodes per 1000 catheter days and increases linearly with the duration of catheter use. Given the high prevalence of CVC use and its direct association with catheter-related bacteremia, which adversely impacts morbidity and mortality rates and costs among HD patients, several prevention measures aimed at reducing the rates of CVC-related infections have been proposed and implemented. As a result, a large number of clinical trials, systematic reviews, and meta-analyses have been conducted in order to assess the effectiveness, clinical applicability, and long-term adverse effects of such measures. In the following article, prophylactic measures against CVC-related infections in HD patients and their possible advantages and limitations will be discussed, and the more recent literature on clinical experience with prophylactic antimicrobial lock therapy in HD CVCs will be reviewed.

Tropical Healthcare Epidemiology: Weather Determinants of the Etiology of Bloodstream Infections in a Brazilian Hospital

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Presence of infectious agents and co-infections in diarrheic dogs determined with a real-time polymerase chain reaction-based panel

Background: Infectious diarrhea can be caused by bacteria, viruses, or protozoan organisms, or a combination of these. The identification of co-infections in dogs is important to determine the prognosis and to plan strategies for their treatment and prophylaxis. Although many pathogens have been individually detected with real-time polymerase chain reaction (PCR), a comprehensive panel of agents that cause diarrhea in privately owned dogs has not yet been established. The objective of this study was to use a real-time PCR diarrhea panel to survey the frequencies of pathogens and co-infections in owned dogs attended in a veterinary hospital with and without diarrhea, as well the frequency in different countries. Feces samples were tested for canine distemper virus, canine coronavirus, canine parvovirus type 2 (CPV-2), Clostridium perfringens alpha toxin (CPA), Cryptosporidium spp., Giardia spp., and Salmonella spp. using molecular techniques.Results: In total, 104 diarrheic and 43 control dogs that were presented consecutively at a major private veterinary hospital were included in the study. Overall, 71/104 (68.3%) dogs with diarrhea were positive for at least one pathogen: a single infection in 39/71 dogs (54.9%) and co-infections in 32/71 dogs (45.1%), including 21/32 dogs (65.6%) with dual, 5/32 (15.6%) with triple, and 6/32 (18.8%) with quadruple infections. In the control group, 13/43 (30.2%) dogs were positive, all with single infections only. The most prevalent pathogens in the diarrheic dogs were CPA (40/104 dogs, 38.5%), CPV-2 (36/104 dogs, 34.6%), and Giardia spp. (14/104 dogs, 13.5%). CPV-2 was the most prevalent pathogen in the dual co-infections, associated with CPA, Cryptosporidium spp., or Giardia spp. No statistical difference (P = 0.8374) was observed in the duration of diarrhea or the number of deaths (P = 0.5722) in the presence or absence of single or co-infections.Conclusions: Diarrheic dogs showed a higher prevalence of pathogen infections than the controls. Whereas the healthy dogs had only single infections, about half the diarrheic dogs had co-infections. Therefore, multiple pathogens should be investigated in dogs presenting with diarrhea. The effects of multiple pathogens on the disease outcomes remain unclear because the rate of death and the duration of diarrhea did not seem to be affected by these factors.

Relationships between oral infections and blood glucose concentrations or hba1c levels in normal and diabetic rats

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Epidemiology of healthcare-associated infections among patients from a hemodialysis unit in southeastern Brazil

Patients submitted to hemodialysis are at a high risk for healthcare-associated infections (HAI). Presently there are scarce data to allow benchmarking of HAI rates in developing countries. Also, most studies focus only on bloodstream infections (BSI) or local access infections (LAI). Our study aimed to provide a wide overview of HAT epidemiology in a hemodialysis unit in southeastern Brazil. We present data from prospective surveillance carried out from March 2010 through May 2012. Rates were compared (mid-p exact test) and temporally analyzed in Shewhart control charts for Poisson distributions. The overall incidence of BSI was 1.12 per 1000 access-days. The rate was higher for patients performing dialysis through central venous catheters (CVC), either temporary (RR = 13.35, 95% CI = 6.68-26.95) or permanent (RR = 2.10,95% CI = 1.09-4.13), as compared to those with arteriovenous fistula. Control charts identified a BSI outbreak caused by Pseudomonas aeruginosa in April 2010. LAI incidence was 3.80 per 1000 access-days. Incidence rates for other HAI (per 1000 patients-day) were as follows: upper respiratory infections, 1.72; pneumonia, 1.35; urinary tract infections, 1.25; skin/soft tissues infections, 0.93. The data point out to the usefulness of applying methods commonly used in hospital-based surveillance for hemodialysis units. (C) 2013 Elsevier Editora Ltda. All rights reserved.

Diagnostic accuracy of semi-quantitative and quantitative culture techniques for the diagnosis of catheter-related infections in newborns and molecular typing of isolated microorganisms

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Healthcare-associated infections: challenges to public health in Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Ecological competition and the incidence of Acinetobacter baumannii bloodstream infections in a teaching hospital in Southeastern Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Leaf-cutting ants: an unexpected microenvironment holding human opportunistic black fungi

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Blood Profile and Histology in Oral Infections Associated with Diabetes

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Identification of Corynebacterium spp. isolated from bovine intramammary infections by matrix-assisted laser desorption ionization-time of flight mass spectrometry

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Molecular analysis of community-acquired methicillin-resistant Staphylococcus aureus isolated from skin and soft tissue infections, Botucatu Medical School, Brazil

Community acquired methicillin Staphylococcus aureus (CA-MRSA) was first reported in 1981, infecting people without risk factors. These strains harbor the Staphylococcal Cassette Chromosome mec (SCCmec) type IV, which contains the mecA gene codifying for methicillin resistance. CA-MRSA strains usually carry PVL (Panton-Valentine Leukocidin), a virulence factor responsible for tissue invasion, causing systemic infections and leading to serious complications. The aims of this work were to detect the mecA gene, SCCmec characterization and to detect the PVL gene of the S. aureus strains isolated from patients diagnosed with skin and soft tissue infections attending the Dermatology Service, of the Botucatu Medical School, Brazil. Among 127 collected samples, 66 (51.9%) were S. aureus and, from these, 7 (10.6%) harbored mecA gene, 3 (42%) with cassette type IV, and none of these samples carried the PVL gene, but it was detected in 10 (15.1%) samples of S. aureus methicillin sensitive (MSSA). Our study suggests the S. aureus strains that harbor PVL gene and MRSA are present in the community as important pathogens.

Fungos melanizados associados a formigas cortadeiras (Formicidae: Tribo Attini)

Leafcutter ants are considered pests in agriculture for their impact in human crops, as they behave utilizing foliar fragments to raise their simbiont fungi (Agaricales: Lepiotaceae) inside their nest. Recent studies have noticed that other fungi may be associated to ants inside their nests, for instance, fungi with melanized wall, known by “dematiaceous”. Historically, many black fungi have been noticed as fitopathogens of many plant cultures with economic importance, highlighting dematiaceous ecological behavior importance in this study. This investigation had the purpose of amplifying ecological knowledge of this fungi, isolating and identificating dematiaceous fungi found in Attini nests, having the intention of understanding plant pathogens dispersion by ants. In this work, 66 isolates were characterized in the following genus: Aspergillus, Penicillium, Paecilomyces, Oxyporus, Rhodotorula, Bipolaris, Curvularia, Fusarium, Giberella, Paraphaeosphaeria, and Cladosporium. The genus Bipolaris, Curvularia, Fusarium and Giberella are known for their opportunistic behaviour, with some published human infections in literature. Fusarium is a notorious fitopathogen, with wide number of descriptions and studies involving pathogenicity development, biochemistry and genetics. The isolates outline is of phyto – associated (phytopathogens, endophytic or epiphitic), fulfilling this work intention in alarming fungi capacity of dispersal by ants. The comprehension of phytopathogenical processes may be clarified based on the knowledge of oportunistics fungi that may utilize ants bodies for their own dispersal. The identification of isolates with capacity of infecting humans brings out public health issues.

Adesão de Paracoccidioides brasiliensis e outros fungos anemófilos a teias de aranhas: implicações para a identificação de nichos microbianos no ambiente

The dimorphic pathogenic fungus, Paracoccidioides brasiliensis (Pb), is the etiological agent of paracoccidioidomycosis (PCM), the most important systemic mycosis in Latin America. While the yeast phase can be isolated from patients affected by paracoccidioidomycosis, dogs and naturally infected armadillos; several elements related to the ecology of the saprophytic phase of the pathogen, which is responsible for the production of infective propagules, are poorly understood, hampering the adoption of preventive measures. The demonstration of the high incidence of Pb infection in the 9- banded armadillo, Dasypus novemcinctus, has opened new perspectives for the identification of the pathogen’s habitat. At the opening of the armadillos’ burrows, spider webs are commonly found. The objective of this study was to evaluate the presence of Pb in spider webs samples related to the habitat of armadillos. Spider web samples were collected at Lageado Farm, Botucatu/SP and prepared for microscopic, molecular and mycological analyses. Microscopic analysis showed that different fungi were closely attached to spider web samples. Nested-PCR reaction showed positive amplification for Pb in 4 samples, with identity confirmed by amplicon sequencing. Fungal colonies also included members of Aspergillus, Blastobotrys, Penicillium, Candida, and Sporothrix genera, which are related to opportunistic disease and primary infections of great medical importance. In vitro adhesion tests of mycelia and yeast form of Pb to the spider webs were also performed, in order to analyze the possible physical attraction between fungal cells and the spider web protein network. The results showed a clear adherence of fungal particles to spider webs. In the current literature, there are no studies reporting adhesive properties of microorganisms to spider webs... (Complete abstract click electronic access below)

Rodococose equina: uma revisão com ênfase na fisiopatogenia e tratamento

The rhodococcosis affects humans and animals. Equine are the most important species for rhodococcosis, which is considered the most debilitating disease in the creation of foals, leading to a mortality rates greater than 50% in this category. The disease is caused by Rhodococcus equi, a bacteria considered as a soil-born opportunistic microorganism, intracellular and ubiquitous. The disease in horses is manifested mainly in the form of pyogranulomatous pneumonia and less often in the form of enteric disorders and / or joint disorders. Transmission occurs mainly by ingestion of contaminated food and water, and inhalation in contaminated environment. The organism has mechanisms of evasion of the immune system, maintain viable in inside phagocytic cells, and induces piogranulomatous infections, leading to lesions of difficult treatment using conventional antimicrobials. Lipophilic drugs with good intracellular activity are required to successful treatment. The conventional treatment for foals is based on the combination of erythromycin and rifampin. However, there is a growing concern about the emergence of resistant strains, which makes increasingly studies on the development of alternative antimicrobials for therapy